Provider Demographics
NPI:1184189938
Name:COULTER, LINDSEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:COULTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1752
Mailing Address - Country:US
Mailing Address - Phone:254-722-6963
Mailing Address - Fax:
Practice Address - Street 1:6130 E. 56TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-1752
Practice Address - Country:US
Practice Address - Phone:432-363-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist